WASHINGTON, June 26 -- As Congress heads into the July 4th recess, one Senate committee has plowed through the less controversial aspects of its healthcare reform legislation, while the panel with the best chance of bipartisan agreement announced cost savings but has yet to introduce formal legislation.

In the Senate Health, Education, Labor and Pensions (HELP) Committee this week, bipartisan bickering continued over the 600-page bill as the panel finished work on the quality, workforce, prevention, and fraud and abuse provisions.

A heated exchange boiled over when a Sen. Judd Gregg (R-N.H.) pushed an amendment that would cap medical malpractice awards against obstetricians and gynecologists.

"In rural and urban areas there is a tremendous shortage of ob/gyns, and it's driven almost entirely because of the adverse effect from trials," Gregg said.

Sen. Sheldon Whitehouse (D-R.I.), former state attorney general, vehemently protested the amendment saying it was unfair to patients who were injured from medical errors.

Acting Chairman Sen. Christopher Dodd (D-Conn.) said there is no evidence that physicians are more likely to practice so-called defensive medicine in states that lack malpractice caps.

The panel's physician, Sen. Tom Coburn (R-Okla.) disagreed.

"To say it doesn't change anything is wrong. It does change things. It turns the patient into an adversary, he said, adding that he was speaking from personal experience.

"When you have experienced this, it totally changes the way you practice medicine," Coburn said.

Later in the week, the committee breezed through the prevention section of the bill, which includes funding for community wellness programs and other public heath initiatives.

"This prevention and wellness section -- if we can hold this and keep it in the final bill as we go all the way through -- is going to make a huge difference in how we practice medicine," said Sen. Tom Harkin (D-Iowa)

Among the amendments adopted by the committee this week were:

A provision to allow medical students to defer loan repayment until they finish their residencies

Limits on the types of expenses medical students cover with loan funds

An provision to promote and fund research on pain management

Inclusion of alternative medicine workers in the bill's definition of "healthcare workforce"

When the HELP committee returns from recess on July 6, it will take up a section on long-term care, which the Congressional Budget Office (CBO) said would cost $60 billion over 10 years.

That section would create a voluntary, long-term insurance program with a monthly premium of about $65 (but only $5 for low-income people and students). The insurance plan would provide long-term care benefits --including institutional or home-based care -- after five years of premiums.

The plan would achieve some savings by easing the burden on Medicaid for patients with functional disabilities, according to a senior Democratic adviser on the HELP committee.

After the long-term section, the committee will take up the controversial section that would create a government-run public plan to compete with private plans. That has yet to be "scored" for budget impact by the CBO.

HELP's acting chairman Sen. Christopher Dodd has said he wouldn't take up a section of the bill until it has a dollar figure attached.

Meanwhile, members of the Senate Finance Committee met all week in an effort to trim billions from their reform plan.

Originally, the CBO had estimated the cost to be around $1.6 trillion, which some Republicans called too high.

So on Thursday, Finance Chairman Max Baucus (D-Mont.), announced that the CBO had scored his bill at under $1 trillion. Still, Republicans said no consensus has been reached yet on the meat of the legislation.

After recess, the panel is expected to continue work on a "bipartisan" bill, according to a release from the committee, although it's unclear when a formal bill is expected for markup.

On the other side of the Capitol, the House Energy and Commerce Health Subcommittee held hearings all week on healthcare reform.

On Thursday, it heard a panel representing physicians, nurses, public hospitals, community health centers and pharmacists offer tepid praise for some aspects of the House plan.

Ted Epperly, MD, president of the American Academy of Family Physicians, told the panel he favored the House draft bill, which promises better payments for primary care physicians, but expressed hesitation over a public health insurance plan that would reimburse providers at Medicare rates. (See It's Official: House Healthcare Reform Bill Scraps SGR)

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